Analysis of appropriate tetanus prophylaxis in an Emergency Department

Background: In this study, our aim was to identify the validity of the prophylaxis indications for patients who received tetanus prophylaxis, determine the ratio of high-risk wounds to the number of patients with immunity, and to evaluate the tetanus immunity of specific age groups.
Methods: Patients who applied to the Emergency Department (ED) between September 2009 and May 2010 and who were considered for tetanus prophylaxis by his/her primary care physician were included in the study.
Results: A total of 320 patients were evaluated. The average age of the patients was 40.87±15.83 years. A total of 73.1% of the patients were male and 26.8% were female. A total of 40.3% of the patients knew their vaccination history, while 59.7% had no recollection of their vaccination history. 14.7% of the patients had received their last dose within 5 years and 48.1% within 5-10 years; 37.2% of the patients declared that more 10 years had passed since their last vaccination. In 75% of the patients, the tetanus immunoglobulin (Ig)G level was identified as ≥0.1 IU/ml, while 25% of the patients had levels <0.1 IU/ml. The number of patients with protective levels was lower among those who were illiterate or who had only a primary school education, and this difference was statistically significant (p<0.001).
Conclusion: The vaccination histories can be misleading. Certain equipment can be used at the bedside to determine a patient’s tetanus immunization status.

Acil serviste yapýlan tetanoz proflaksisi uygunluðunun analizi

Amaç: Bu çalýþmada, tetanoz profilaksisi verilen hastalarýn profilaksi endikasyonunun doðruluðu, hekim tarafýndan tetanoz riskli kabul edilen yaralarýn ve bu hastalarýn baðýþýklýk oranýnýn belirlenmesi, belirli yaþ gruplarýnýn tetanoz baðýþýklýðýnýn deðerlendirilmesi amaçlandý.
Gereç Ve Yöntem: Eylül 2009-Mayýs 2010 tarihleri arasýnda Uludað Üniversitesi Týp Fakültesi Acil Servis’ine (AS) baþvuran ve birinci basamak hekimi tarafýndan tetanoz profilaksisi verilmesi uygun görülen hastalar bu çalýþmaya alýndý.
Bulgular: Toplam 320 hasta deðerlendirildi. Hastalarýn yaþ ortalamasý 40,87±15,83 idi. Hastalarýn %73,1’i erkek, %28,6’sý kadýndý. Hastalarýn %40,3’ü aþýlama geçmiþini biliyorken, %59,7’si aþýlanma geçmiþini hatýrlamýyordu. Hastalarýn %14,7’si son dozunu beþ yýl içinde alýrken, %48,1’i 5-10 yýl içinde almýþtý ve %37,2’si 10 yýldan daha fazla bir süre önce son kez aþýlanmýþtý. Hastalarýn %75’inde tetanoz immünglobulin (Ig)G düzeyi ≥0,1 IU/ml ve %25’inde tetanoz IgG düzeyi <0,1 IU/ml olarak saptandý. Okuma yazma bilmeyenlerde ya da sadece ilkokul mezunu olanlarda tetanoz baðýþýklýðý için koruyucu düzeyler daha düþüktü ve bu fark istatistiksel olarak anlamlý idi (p<0,001).
Sonuç: Hastalardan alýnan aþýlanma öyküleri yanýltýcý olabilir ve bu amaçla hastalarýn yatak baþý tetanoz baðýþýklýk durumunun test edilebileceði cihazlar kullanýlabilir.